Provider Demographics
NPI:1306113444
Name:GOOD, PAMALA LYN (DMD)
Entity type:Individual
Prefix:DR
First Name:PAMALA
Middle Name:LYN
Last Name:GOOD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 MOSSY CREEK LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-3638
Mailing Address - Country:US
Mailing Address - Phone:850-228-7333
Mailing Address - Fax:
Practice Address - Street 1:2808 REMINGTON GREEN CIR STE 100
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-3724
Practice Address - Country:US
Practice Address - Phone:850-383-1052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 195861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice